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Anthem Blue Cross Blue Shield of Colorado prior authorization code reference, page 86

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Source code lookup

Each row links an imported source code to its service or category label. Check the original document for the complete plan scope, review type and qualifications.

Source code index

Imported source codes and labels; verify the complete review requirements in the original document
CodeDescriptionSource
S9502Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hoursColorado Prior Authorization List, Pg 178 Original policy
S9503Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every six hoursColorado Prior Authorization List, Pg 178 Original policy
S9504Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every four hoursColorado Prior Authorization List, Pg 178 Original policy
S9960Ambulance service, conventional air services, nonemergency transport, one way (fixed wing)Colorado Prior Authorization List, Pg 178 Original policy
S9961Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)Colorado Prior Authorization List, Pg 178 Original policy
T1000Private duty/independent nursing service(s) - licensed, up to 15 minutesColorado Prior Authorization List, Pg 178 Original policy
T1002RN services, up to 15 minutesColorado Prior Authorization List, Pg 178 Original policy
T1003LPN/LVN services, up to 15 minutesColorado Prior Authorization List, Pg 178 Original policy
T1030Nursing Care, In The Home, By Registered Nurse, Per DiemColorado Prior Authorization List, Pg 178 Original policy
T1031Nursing Care, In The Home, By Licensed Practical Nurse, Per DiemColorado Prior Authorization List, Pg 178 Original policy
T2036Therapeutic camping, overnight, waiver; each sessionColorado Prior Authorization List, Pg 178 Original policy
T2037Therapeutic camping, day, waiver; each sessionColorado Prior Authorization List, Pg 178 Original policy
V2787Astigmatism correcting function of intraocular lensColorado Prior Authorization List, Pg 178 Original policy
V2788Presbyopia correcting function of intraocular lensColorado Prior Authorization List, Pg 178 Original policy
V2790Amniotic MembraneColorado Prior Authorization List, Pg 178 Original policy
V5095Semi-Implantable Middle Ear Hearing ProsthesisColorado Prior Authorization List, Pg 178 Original policy
V5298Hearing Aid, Not Otherwise ClassifiedColorado Prior Authorization List, Pg 178 Original policy
V5362Speech ScreeningColorado Prior Authorization List, Pg 179 Original policy
V5363Language ScreeningColorado Prior Authorization List, Pg 179 Original policy
V5364Dysphagia ScreeningColorado Prior Authorization List, Pg 179 Original policy

Sources

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Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

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